Ibuprofen associated with blood pressure rise in arthritis patients at CVD risk

According to the European Society of Cardiology, ibuprofen is associated with increased blood pressure and hypertension compared to celecoxib in patients with osteoarthritis or rheumatoid arthritis and increased risk of cardiovascular disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs), both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, are among the most widely prescribed drugs worldwide, but are now linked with increased blood pressure and adverse cardiovascular events.

NSAID labels include warnings about potential increases in blood pressure but there is little data on the effects of individual drugs. Maintaining or achieving blood pressure control in patients with arthritis and concomitant hypertension could avoid more than 70,000 deaths from stroke and 60,000 deaths from coronary heart disease each year.

The study which found the results, PRECISION-ABPM, was a prospective, double blind, randomised, non-inferiority cardiovascular safety trial. It was conducted at 60 sites in the US and included 444 patients, of whom 408 (92%) had osteoarthritis and 36 (8%) had rheumatoid arthritis. All patients had evidence of, or were at increased risk for, coronary artery disease.

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Patients were randomised in a 1:1:1 fashion to receive celecoxib (100–200mg twice a day), ibuprofen (600–800mg three times a day), or naproxen (375–500mg twice a day) with matching placebos.

Principal investigator Prof Frank Ruschitzka, professor of cardiology and co-head, Department of Cardiology, University Heart Centre, Zurich, Switzerland, said: “PRECISION-ABPM showed differential blood pressure effects between the different NSAIDs, ibuprofen and naproxen, and the COX-2 inhibitor celecoxib. While celecoxib and naproxen produced either a slight decrease (celecoxib) or a relatively small increase (naproxen) in blood pressure, ibuprofen was associated with a significant increase in ambulatory systolic blood pressure of more than 3mmHg.”

“Patients receiving ibuprofen had a 61% higher incidence of de novo hypertension compared to those receiving celecoxib,” Prof Ruschitzka continued.

These results support and extend the findings of the PRECISION trial, demonstrating non-inferiority for the primary cardiovascular outcomes for moderate doses of celecoxib compared with naproxen or ibuprofen.

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Smartphone app may help older adults manage serious mental illness and chronic health conditions

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The use of new technologies in geriatric psychiatry shows promise for advancing personalised medicine and improving patient care. A new study in The American Journal of Geriatric Psychiatry describes the successful adaptation of an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness.

Care of middle-aged and older patients with serious mental illness can be difficult. Often these patients suffer from other medical conditions and are at increased risk of premature death. In order to help patients cope with their illness, researchers from Dartmouth developed a smartphone-based intervention using adaptive systems engineering framework and principles of user-centred design.BJHC_elderlylady_mobile_mini_0_8

“The use of mobile health interventions by adults with serious mental illness is a promising approach that has been shown to be highly feasible and acceptable,” explained lead investigator Karen L. Fortuna, PhD, of the Dartmouth Centers for Health and Aging and the Geisel School of Medicine at Dartmouth.

They found that even patients with limited technical abilities could use this app successfully. The app and intervention protocol were developed using commercially available products from Wellframe.

Following multiple design iterations, investigators tested the app’s usability and found Ten participants with serious mental illness and other chronic health conditions reported a high level of usability and satisfaction with the smartphone application.

The app takes patients through 10 sessions over a period of around three months, covering topics such as stress vulnerability and illness, medication adherence and strategies, and substance and medication abuse. Physicians can remotely monitor app use, and intervene when problems are detected, facilitating telemedicine for less accessible populations.

This study is part of a special issue of The American Journal of Geriatric Psychiatry that captures an important moment in the evolving relationship between technology and the clinical care of

 

Vitamin B3 could prevent miscarriages and birth defects

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An extra dose of vitamin B3 might help prevent certain kinds of complex birth defects, according to a new study. It is thought the vitamin can help compensate for defects in the body’s ability to make a molecule, nicotinamide adenine dinucleotide (NAD), which researchers have now linked for the first time to healthy fetal development in humans.

Every year 7.9 million babies are born with a birth defect worldwide. The discovery suggests the possibility that boosting levels of B3 in pregnant women’s diets might help lower overall rates of birth defects.

Researchers from the Victor Chang Institute in Sydney called it ‘a double breakthrough’ as they found both a cause and a preventative solution. The researchers analysed the DNA of four families where the mothers had suffered multiple miscarriages or their babies were born with multiple birth defects, such as heart, kidney, vertebrae and cleft palate problems.

They found mutations in two genes that caused the child to be deficient in a vital molecule known as Nicotinamide adenine dinucleotide (NAD), which allows cells to generate energy and organs to develop normally. Lead researcher Prof Sally Dunwoodie replicated these mutations in mice and found they could be corrected if the pregnant mother took niacin (vitamin B3).

“You can boost your levels of NAD and completely prevent the miscarriages and birth defects. It bypasses the genetic problem,” she said. “It’s rare that you find a cause and a prevention in the same study. And the prevention is so simple, it’s a vitamin,” she said.

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Back In 2005, Dunwoodie’s team dealt with a particularly severe case, a baby who had major defects in the heart, backbone, and ribs; the rib problems being so bad that the child’s lungs couldn’t fully inflate. The team found that the family carried a mutation in a gene related to the production of NAD, a molecule crucial for energy storage and DNA synthesis in cells. Both parents carried a mutation in one of their copies of the gene, and the affected baby had inherited two defective copies.

No one had reported any role for NAD in heart or bone development, Dunwoodie says. “We didn’t know what to do with it.”

To confirm the role of the mutations in organ and bone development, the researchers knocked out the two genes in mice to see whether similar birth defects appeared. At first all the pups were normal. But then the researchers realised that standard mouse chow is rich in niacin and that cells can use either niacin or nicotinamide—both known together as vitamin B3—to make NAD by an alternate pathway.

The work opens a potentially exciting new area of research for developmental biologists: Trying to understand how cell metabolism affects development

 

 

The future of diagnostic wearables?

 

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The University of Tokyo has recently started to develop a new generation of wearable diagnostics. The hypoallergenic electronic sensor wearables are designed to monitor health indicators without being invasive or causing any discomfort.

The electronic sensors are made up of breathable nanoscale meshes that attach directly to the skin to produce accurate and precise readings of heart rate and other health indicators. Japanese scientists believe the new wearables can be worn for up to one week, without causing any irritation. However, if devices are worn over a longer period it is thought they may be deemed unsafe, as they prevent breathability and block airflow causing irritation and inflammation.

“We learned that devices that can be worn for a week or longer for continuous monitoring were needed for practical use in medical and sports applications” says Professor Takao Someya at the University of Tokyo’s Graduate School of Engineering.

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The device can be applied by spraying a small amount of water, which dissolves PVA nanofibres to allow it to stick to the skin. It is designed to fit curvilinear surfaces of skin making it ideal to apply to sweat pores and index fingers.

Scientists are hopeful this is the beginning of a new chapter for wearable diagnostics and hope that it will be possible to measure health indicators without causing stress or discomfort to the user. The device is thought to not only be the future for medical diagnostics, but also have applications for sports technology.

 

 

Q1 2017: Early analysis of the global OTC performance

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Nicholas Hall’s global OTC database, DB6, has just published its latest figures relating to the Q1 2017 performance of the OTC market, and below are some standout trends based on early analysis of the data. Over the coming weeks, our OTC INSIGHT research teams will be compiling the latest trend info at a regional and Top 20 country level, and we’ll alert you as soon as this analysis has been uploaded to the OTC DASHBOARD website.

1. Russia returns to higher growth (+18.2% MAT Q1 2017 vs +11.3% full-year 2016)

A key factor in the slightly improved performance of the global OTC market in the 12 months to end-March 2017 (+4.5%) vs full-year 2016 (+4.3%) was higher growth in Russia. While a modest upturn in the world’s No.1 OTC market, USA, was offset by decelerating growth for both No.2 market China and No.3 market Japan, it was the European countries – largely No.5 Russia, but also No.4 Germany – that accounted for the improved performance of the global OTC market in Q1 2017.

2. CCA growth at the heart of Europe’s revived fortunes in Q1 2017

Global CCA sales were up 4.7% in 2016, thanks to a strong end to the year, and this trend continued into the first quarter of 2017, with growth accelerating to 6.3% in the MAT Q1 2017 period. Europe was largely behind this upsurge, with CCA growth in Western Europe showing a marked improvement (+3.8%), while Central & Eastern Europe was the biggest source of dynamism (+17.8%), led by Russia and Poland. This trend extended to the rest of the northern hemisphere, with North America also reporting higher CCA growth (+4.4%) in the MAT Q1 2017 period, with Canada especially vibrant (+6.9%).

3. Global Top 5 stays the same, but J&J may overtake Sanofi by mid-year

While the Top 5 global OTC marketers – GSK, Bayer, Sanofi, J&J and Pfizer – remain fixed in position and adrift from the rest of the competition, the battle for the No.3 spot between Sanofi (+3.8%) and J&J (+4.1%) continues to intensify. On current trends, it looks as though J&J may overtake Sanofi by the end of Q2 2017, and we will confirm the outcome of this battle later in the year.

In the meantime, please check your weekly briefings and OTC DASHBOARD‘s Charts & Graphs archive for more early analysis of the Q1 2017 results over the coming weeks.

Q3 Results Reveal USA Slowdown

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The Q3 2016 results are now available on Nicholas Hall’s DB6 database, and the trend information will soon be updated on the OTC DASHBOARD website. In this week’s blog, we take a closer look at the latest growth trends for the Top 20 OTC markets in the world.

Overall, the global OTC market performed steadily in Q3 2016 with a 4.3% rise, the same growth rate as we saw in Q2 2016. However, this performance can be seen as mediocre compared to the full-year 2015 period, when OTC sales were up by 5.5%.

The global No.1 market, USA, showed signs of deceleration in Q3, with sales up by only 2.2%. This is largely owing to the slowing down of sales for major switches, such as Flonase allergy remedy and Pfizer’s Nexium 24HR antacid. That said, the USA should enjoy an upturn in the new year with switches such as GSK’s Flonase Sensimist (allergy remedy) and Galderma’s Differin Gel (acne remedy) in the pipeline. Compared to other categories, Lifestyle OTCs in the USA showed continued dynamism in Q3 2016, with sales up by a steady 5.0%; this was owing in part to double-digit growth for obesity treatments (+43.4%).

China’s growth also continued to lose steam in Q3 2016, where sales were up by 6.0%. China’s OTC market continues to grow year-on-year, but in recent years growth has gradually slowed; this is considered to be owing to a weaker economy, new regulations and also the crackdown on MNCs and domestic companies. Weaker growth overall in Q3 came despite continued growth for analgesics, which were up by 8.4%, making it the most dynamic OTC category in China, thanks to high levels of innovation and advertising in this area.

In Q3, growth also weakened in Japan and Europe as a result of low levels of Rx-to-OTC switch activity and weak cough, cold & allergy growth in early 2016. Italy was an exception to sluggish growth in Europe, where sales of OTCs were up by 3.5%; this was thanks to strong growth for Lifestyle OTCs (+11.1%), with a particularly dynamic performance from emergency hormonal contraceptives, sales of which rose by 226%.

Latin America remains the strongest performing region, with growth up by 15%. This is thanks to significant growth from Venezuela, up by 39% in Q3, owing to high levels of inflation. Despite a tough economic climate in Brazil, the OTC market remains robust with sales up by 9.5%, as a result of increased awareness of health and wellbeing.

Elsewhere in Q3 2016, India’s growth accelerated with sales up by 9.5%, owing to a strong performance from gastrointestinals (+10.3%). Turkey also performed well with growth up by 6.8%, thanks to VMS sales and a strong upturn for Lifestyle OTCs.

Kraków Conference Debrief

I hope you’ve now had a chance to explore our full-year 2015 OTC Market Stats update, which includes up-to-date OTC trends and sales data at global, regional and country level (with the addition of Algeria and Morocco this year). I’ll be covering the key results as usual in the next tutorial blog, but for now, here’s your exclusive round-up from Nicholas Hall & Company’s latest event – Regards, Owen Hartnett.

Another successful conference

Nicholas Hall’s OTC INSIGHT 27th European Conference & Action Workshop was held in the beautiful Polish city of Kraków. Representatives from some of the world’s leading companies detailed their strategies to build sustainable OTC brands while delivering real benefits to the consumer, with all in agreement that the consumer must be at the heart of the brand for it to succeed (this year’s theme was indeed “Building Blocks for a Successful OTC Brand”). It was a great pleasure to meet people so passionate about our industry during the Networking Hours and coffee breaks in which I was conducting live OTC DASHBOARD demo sessions.

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An OTC DASHBOARD segment will feature in the upcoming conference video

One standout topic for me was the need for the consumer healthcare industry to engage with digital by choice, not necessity. Nick Melnyk, Managing Director of Central & Eastern Europe at Sanofi, warned that we could end up working for tech giants in future if we aren’t better equipped and more willing to turn to a digital strategy, noting that it is not the most adaptable who survive, but those who disrupt. Our ever-growing OTC DASHBOARD client base suggests a lot of you are already utilising healthcare data in this way, but we are still a long way off in terms of digital, especially in comparison to industries such as media, telecom and FMCG.

Thursday evening saw the return of the prestigious OTC Marketing Awards Ceremony, sponsored by Medical Brands. With so many talented marketers in the room, picking a winner for each award was far from easy, but the recipients below are certainly worthy winners in their respective categories.

Flonase_asset2Most Innovative Global OTC Marketing Campaign 2016

GSK’s early-2015 launch of Flonase Allergy Relief (following Rx-to-OTC switch approval) has garnered over US$300mn in sales, while remembering to put the consumer at the very heart of its brand proposition. Nick Srikanth, Chief of Staff, Europe Americas Region, graciously collected the award.

Screen Shot 2016-04-29 at 11.13.44The 2016 Colin Borg Award for the Best European OTC Advertising

Focusing on the special connection between father and son, P&G’s #HugYourDad campaign for Wick VapoRub Germany is a great example of a brand connecting emotionally with its consumers. Anna Sacha, Global Head, Consumer & Market Insights, was on hand to claim the top prize.

Screen Shot 2016-04-29 at 11.35.40Most Innovative New Product of the Year 2016

RB’s Strepsils Flurbiprofen Spray (Dobendan / Benactivdol Gola in other markets) wins this year’s Most Innovative accolade as it is the first OTC flurbiprofen product of its kind in a convenient spray format. A delighted Akhil Chandra, Global Category Director Analgesics, received the award.

Nicholas Hall concluded that people must be at the heart of innovation (basis of the newly-launched OTC Training Academy) and closed the conference by revealing the destination for next year’s event: Munich, Germany. I very much look forward to seeing some of you then, or perhaps actually much sooner, as the next stop in the OTC DASHBOARD calendar is the 52nd AESGP Annual Meeting in Athens!

OTC DASHBOARD is a subscription-only web service powered by Nicholas Hall’s DB6 Global OTC Database. To find out how we can help you to save time, work smarter and keep connected, get in touch with us today at: otcdashboard@NicholasHall.com